Allercy and Asthma Health
The Official Publication of AAN - MA

What You Need To Know about the Dangers of Hookah (Waterpipe) Smoking

by Mary P. Martinasek, PhD, RRT


Worldwide today there are approximately 100 million daily waterpipe—or hookah—smokers. Hookah smoking is often the centerpiece of social interaction in coffeehouses in the Middle East and is becoming more prevalent in restaurants and hookah bars in the U.S.

The social acceptability and togetherness that hookah smoking produces has extended on to college campuses and surrounding hookah bars in the United States. It has been estimated that 10–20% of college students engage in hookah smoking regularly and another 40–50% have tried hookah smoking. High school students are also adopting the practice of waterpipe smoking at an alarming rate. This form of socializing can be enticing but harmful for adolescents and young adults, and it can be especially dangerous for people who have asthma and other underlying lung problems.

The spread of hookah smoking has been attributed to the introduction of flavored tobacco, known as maassel. Maassel is tobacco that has been combined with dried fruits, honey, glycerin, and added flavorings ranging from apple, bubble gum, chocolate, frappacino, mint, orange soda, and root beer to melon.

Hookah smoking involves a combination of tobacco, water, wood charcoal, and the waterpipe device. Because tobacco is used in the waterpipe, similar carcinogens that are in cigarette tobacco are also found in hookah tobacco. It is these carcinogens that are the main components in mainstream smoke and the precursors to respiratory ailments. But worse still, hookah smoking requires larger inhaled respiratory volumes, which actually expose the smoker to more carcinogens and harmful chemicals than cigarette smoke.

Hookah smoke contains an increased amount of nickel, arsenic, and cobalt as a result of the burning charcoal. Although waterpipes do not emit as much side-stream smoke as do cigarettes, the large volumes of mainstream smoke exhaled exposes both the smoker and others to these hazardous chemical components.  The smoke produced is approximately 50 times that of a cigarette.

Tobacco smoking is responsible for 440,000 deaths each year in the United States, and the World Health Organization has declared it a global public health threat. Although hookah smoking is perceived as being less harmful than cigarettes, mounting evidence suggests it contains more harmful agents and has the similar addictive potential like cigarettes due to the nicotine containing tobacco. Additionally, hookah smoking has been found to contribute to the spread of tuberculosis, mononucleosis, oral herpes, and potentially other infectious diseases. With the lack of public health oversight of waterpipes used in hookah smoking, poor sanitation and cleaning procedures raise concerns about the spread of infectious disease, and researchers have, indeed, found that hookah smokers have a higher incidence of chronic bronchitis, depression, and overall decreased quality of life compared to cigarette smokers.  There have also been several reported cases of carbon monoxide toxicity from hookah smoking, which deprives the body of oxygen.

With limited health messages and no current U.S. Food & Drug Administration regulation focused on hookah smoking, it is important to become informed about the negative lung-health related effects associated with hookah smoking. The bottom line is: It is dangerous to smoke hookah tobacco, especially if you have allergies or asthma.

Mary P. Martinasek, PhD, RRT, is a respiratory therapist and research faculty at the College of Public Health, University of South Florida in Tampa, FL.

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